Constipation is a problem for many Americans. Not only is it extremely uncomfortable, it can cause of hemorrhoids, and some studies have found that reduced number of bowel movements is associated with an increased risk of colon cancer – the number 2 cancer killer in America. So in my book living with constipation is not an option.

The problem is the most common recommendations given to overcome constipation, increasing fiber and water intake, often do not take care of the problem or sometimes can create other problems.  For instance, fiber can sometimes increase gas and bloating.

Constipation occurs primarily because of decreased peristalsis, the muscular movement of the intestines that promotes digested food through the GI tract.  But what causes decreased peristalsis? The main cause is not enough bulk to the stool.  That’s what fiber and water are supposed to do – increase bulk.  So what can you do if they don’t work?  For colon health as well as bowel movement regularity you also need to address balance of gut flora and magnesium intake.

Gut flora or probiotics are the beneficial bacteria in human intestines.  They have many functions like helping to digest foods, make vitamins such as B-12 and K, and interfere with disease-promoting bacteria. Probiotic bacteria also produce organic acids (like lactic acid) that in turn help stimulate peristalsis.  Gut flora can be wiped out in the intestines by a number of factors, but the primary one is taking antibiotics.  So, to keep a good supply we have to take them in through diet or supplements.

Eating yogurt may help a little, but the number of beneficial bacteria in a serving of yogurt is very low compared to the number actually needed.  Supplementing with a good human strain probiotic supplement is far better to ensure you are getting enough.

You can help good intestinal bacteria thrive by making sure they have a good food supply.  Friendly intestinal flora feed on oligosaccharides, a type of carbohydrate found in some foods like Jerusalem artichokes, asparagus, onions and garlic.  Foods enriched with inulin (from chicory root) also contain oligosaccarides.  If you don’t like these foods, oligosaccharides can be found in supplement form.  I have found artichoke extract supplements to be extremely helpful for constipation, especially when given along with probiotics.

If probiotics, adequate fiber and water have not adequately alleviated constipation, I turn to magnesium, especially if I see other signs of functional deficiency, like muscle cramps, restless legs, fatigue or headaches. Magnesium helps peristalsis by allowing relaxation of the smooth muscle tissue in the intestinal tract. In chronic long-term constipation, you may need as much as 800 mg. of magnesium per day to eventually get the intestines moving. A well-absorbed form of magnesium is crucial; amino acid chelated forms like magnesium taurate, citrate and glycinate are some of the best supplement forms of magnesium.

For occasional constipation there is nothing wrong with using a laxative, but in chronic constipation laxatives are not appropriate as they can become habit-forming and may have side effects.  Anyone suffering from constipation should look first to probiotics, as they can help you digest and break down dietary fiber.  If increased probiotics, fiber and water don’t do the trick, then look to artichoke as a source of oligosaccharides and finally,  you should magnesium since many studies now have pointed to the fact that most Americans do not get enough magnesium in their diet.

Increased colon cancer risk studies:

1. British Journal of Cancer (2004) 90, 1397-14.

2. Am J Gastroent, Volume 98 Issue 4 Page 857-864, April 2003

3. Epidemiology 1998 Jul;9(4):385-91.

Constipation Risks and Treatment article:

Common Myths About Constipation Disspelled Am J Gastroenterol. 2005;100:232-242

Probiotic References:

Salminen S, et al. 1998. Clinical applications of probiotic bacteria. International Dairy Journal, 8; 563-572.

Survival and therapeutic potential of probiotic organisms with reference to Lactobacillus acidophilus and Bifidobacterium sppImmunology and Cell Biology (2000) 78, 80–88

Laroia S, Martin JH. Bifidobacteria as possible dietary adjuncts in cultured dairy products: A review. Cult. Dairy Prod. J. 1990; 25: 18–22.

Oligosaccharides:

http://www.pdrhealth.com/drug_info/nmdrugprofiles/nutsupdrugs/fru_0313.shtml

Magnesium:

Iannello S, Belfiore F.  Hypomagnesemia, a Review Panminerva Med. 2001 Sep;43(3):177-209.

Susanna C. Larsson, MSc; Leif Bergkvist, MD, PhD; Alicja Wolk, DMSc. Magnesium Intake in Relation to Risk of Colorectal Cancer in Women. JAMA, January 5, 2005;293:86-89.